The human spine is comprised of 24 vertebrae separated from each other by discs that serve as shock absorbers and provide flexibility of the spine. In addition, they serve to allow adequate space for spinal nerves to exit, providing sensation and movement to all parts of the body.
The disc is composed of a thick, tough outer annulus fibrosus - constraining ring primarily composed of collagen and a soft inner core known as the nucleus pulposus which consists of a proteoglycan. A tear in the annulus may cause the nucleus to rupture. If the nucleus pours out through the tear in the annulus, the disc is said to be herniated. Nuclear material, which is displaced into the spinal canal, is associated with a significant inflammatory response. The vertebrae between which the disc lies may press against each other and against the nerves that extend from either side of the vertebra. Compression of a motor nerve results in weakness, and compression of a sensory nerve results in numbness. In this instance, one may experience both back pain from the herniation or tear of the annulus, as well as pain from that part of the body served by the nerve. Radicular pain results from inflammation or compression of the nerve, explaining the lack of correlation between the actual size of a disc herniation with that of clinical symptoms.
What are some symptoms of a herniated disc?
Patients usually feel pain in the lower back and pain or numbness in the legs. The classic presentation of a herniated disc includes the complaint of sciatica (an intractable radiating pain), with associated objective neurological findings of weakness, reflex change or dermatomal numbness.
Spondylosis, or disc degeneration, is sometimes referred to as osteoarthritis. It describes bony overgrowths (osteophytes), predominantly along the anterior, lateral, and less commonly the posterior aspects of the superior and inferior margins of the vertebral bodies. This dynamic process increases with, and is perhaps inevitable with age.
What causes spondylosis?
There is no specific cause of spondylosis and this condition appears to be a natural part of the aging process. Prior injuries or surgery to the spine may increase the risk of developing spondylosis.
What are some symptoms of spondylosis?
There are a number of symptoms of spondylosis that may occur with other spinal conditions. The nature of the symptoms varies depending on the location of the spondylosis.
Spondylosis affecting the cervical spine may cause:
Neck pain that may radiate to, or be felt in, the arms or the shoulders
Weakness or loss of sensations in the shoulders, arms and occasionally the legs
Stiffness in the neck that worsens over time
Problems with balance
Reduced or hyper reflexes
Headaches that tend to originate in the back of the head
Bladder and bowel control problems
Spondylosis affecting the lumbar spine is more elusive and is usually asymptomatic, with no diagnostic or prognostic significance. Given the frequency and size of lumbar osteophytes, they have long been thought to cause back pain. This has led to many studies. These studies reveal that there is no greater frequency of signs or symptoms among individuals with osteophytes than among those without osteophytes.
"I was in a car accident, and I have neck pain as a result."
If you have ever been in a car accident and experienced pain in your neck, you have most likely had whiplash. Whiplash, also called neck sprain or neck strain, is an injury to the soft tissues of the neck. It is usually caused by sudden movement of the neck which forces the head and neck to whip back and forth.
What are the symptoms of whiplash?
The symptoms of whiplash may include neck pain, tenderness and stiffness, headache, dizziness, nausea, shoulder and/or arm pain, numbness and tingling sensation, and in rare cases blurred vision and difficulty swallowing. Most people experience neck pain either immediately after the injury or several days later.
The symptoms usually result from injury to the neck's soft tissues; the intervertebral discs, muscles, and ligaments. Muscle tears characteristically present with burning pain accompanied by tingling sensations. Ligaments affected by excessive joint movement can cause muscles to defensively tighten limiting motion. Age and pre-existing health conditions (e.g., arthritis) may increase the severity of whiplash. As people age range of motion declines, muscles lose flexibility and strength, and intervertebral discs and ligaments lose some of their elasticity.
How is whiplash diagnosed?
A physical examination is performed to evaluate the patient's condition. Initially, the physician orders radiographs (x-rays) to determine if a fracture exists. Depending on the patient's symptoms, a CT scan, MRI, and/or other imaging tests may be necessary to assess the condition of the cervical spine's soft tissues (intervertebral discs, muscles, ligaments).
How is whiplash treated?
Fortunately, whiplash is treatable and most symptoms resolve completely. Treatment options are:
Soft cervical collar
Heat therapy to relieve muscle tension and pain
Range of motion exercises and physical therapy
Therapeutic injections (e.g. epidural steroid injections, cervical medial branch blocks, cervical radiofrequency neurotomy)
During the recovery phase, the goal is to help the patient resume normal activities at their pre-injury level.